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Purpose Workload is a critical concept in the evaluation of performance and quality in healthcare systems, but its definition relies on the perspective (e.g. individual clinician-level vs unit-level workload) and type of available metrics (e.g. objective vs subjective measures). The purpose of this paper is to provide an overview of objective measures of workload associated with direct care delivery in tertiary healthcare settings, with a focus on measures that can be obtained from electronic records to inform operationalization of workload measurement. Design/methodology/approach Relevant papers published between January 2008 and July 2018 were identified through a search in Pubmed and Compendex databases using the Sample, Phenomenon of Interest, Design, Evaluation, Research Type framework. Identified measures were classified into four levels of workload: task, patient, clinician and unit. Findings Of 30 papers reviewed, 9 used task-level metrics, 14 used patient-level metrics, 7 used clinician-level metrics and 20 used unit-level metrics. Key objective measures of workload include: patient turnover (n=9), volume of patients (n=6), acuity (n=6), nurse-to-patient ratios (n=5) and direct care time (n=5). Several methods for operationalization of these metrics into measurement tools were identified. Originality/value This review highlights the key objective workload measures available in electronic records that can be utilized to develop an operational approach for quantifying workload. Insights gained from this review can inform the design of processes to track workload and mitigate the effects of increased workload on patient outcomes and clinician performance.

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Online pro-health social networks facilitating smoking cessation through web-assisted interventions have flourished in the past decade. In order to properly evaluate and increase the impact of this form of treatment on society, one needs to understand and be able to quantify its reach, as defined within the widely-adopted RE-AIM framework. In the online communication context, user engagement is an integral component of reach. This paper quantitatively studies the effect of engagement on the users of the Alt.Support.Stop-Smoking forum that served the needs of an online smoking cessation community for more than ten years. The paper then demonstrates how online service evaluation and planning by social network analysts can be applied towards strategic interventions targeting increased user engagement in online health forums. To this end, the challenges and opportunities are identified in the development of thread recommendation systems using core-users as a strategic resource for effective and efficient spread of healthy behaviors, in particular smoking cessation.

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